Devices and Methods for Guiding Surgical Fasteners

ABSTRACT

Devices and methods are provided for guiding surgical fasteners. In general, the devices and methods can facilitate guidance of fasteners during deployment of the fasteners into tissue. In general, the surgical device can include one or more guidance features configured to facilitate guidance of the fasteners during ejection of the fasteners from the cartridge. The one or more guidance features can be configured to reduce lateral movement of the fasteners during deployment thereof In an exemplary embodiment, each of the one or more guidance features can be configured to support a fastener on three sides thereof during deployment of the fastener. The one or more guidance features can be formed on the cartridge, e.g., formed on a surface thereof or formed on a sled disposed in the cartridge, and/or can be formed on a jaw that seats the cartridge.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application is a divisional of U.S. patent application Ser.No. 14/474,805 entitled “Devices and Methods for Guiding SurgicalFasteners” filed Sep. 2, 2014, which is hereby incorporated by referencein its entirety.

FIELD OF THE INVENTION

The present disclosure relates generally to guiding surgical fasteners.

BACKGROUND

Minimally invasive surgical instruments are often preferred overtraditional open surgical devices due to the reduced post-operativerecovery time and minimal scarring associated with minimally invasiveprocedures. Laparoscopic surgery is one type of minimally invasivesurgery (MIS) procedure in which one or more small incisions are formedin the abdomen and a trocar is inserted through the incision to form apathway that provides access to the abdominal cavity. The trocar is usedto introduce various instruments and tools into the abdominal cavity, aswell as to provide insufflation to elevate the abdominal wall above theorgans. Endoscopic surgery is another type of MIS procedure in whichelongate flexible shafts are introduced into the body through a naturalorifice.

Due to the benefits associated with minimally invasive surgeries,significant efforts have gone into developing a range of endoscopic andlaparoscopic surgical instruments that are suitable for preciseplacement of a distal end effector at a desired surgical site. Thesedistal end effectors engage the tissue in a number of ways to achieve adiagnostic or therapeutic effect (e.g., grasper, cutter, stapler, clipapplier, access device, drug/gene therapy delivery device, and energydevice using ultrasound, radiofrequency, laser, etc.).

For example, staplers including end effectors for grasping tissue havebeen developed which secure tissue between two jaws. Staples containedin one of the jaws can be driven into the grasped tissue and deformed tohold the tissue by impinging on the other jaw. The staples can form apredetermined pattern (e.g., one or more lines of staples) based uponthe configuration of the staples in the one of the jaws. The stapler canbe a linear stapler, in which the predetermined pattern includes one ormore longitudinal lines of staples. Though staplers can be effective tograsp and staple tissue, it can be difficult to grasp and/or staple thetissue based on a variety of factors, such as a size and/or shape of thestaple, a thickness and/or toughness of the tissue, etc.

Some staplers can be refilled after firing staples. In some staplers,the staples can be contained in a cartridge which can be removable fromthe stapler's jaw to allow the stapler to be refilled with staplescontained in another cartridge inserted into the jaw. However, thisrefilling of cartridges can be difficult since the cartridges can berelatively small and accordingly difficult to manipulate and/or properlysecure within the jaw. Refilling a stapler with a new cartridge can thusbe time consuming and/or can result in an improperly loaded cartridgethat can misfire staples or otherwise function improperly during use ona patient.

Accordingly, there remains a need for improved methods and devices forstapling tissue.

SUMMARY

A surgical fastening device includes an elongate shaft and an endeffector coupled to a distal end of the elongate shaft. The end effectorincludes first and second opposed jaws coupled to one another andconfigured to engage tissue therebetween. The device also includes astaple cartridge disposed within the first jaw. The staple cartridgealso includes a plurality of staple-receiving recesses formed therein, aplurality of D-shaped staples configured to rotate about a pivot pointinto tissue engaged between the first and second jaws, wherein eachstaple is disposed within a staple-receiving recess, and a plurality ofguide members formed on the cartridge. Each guide member extends from asurface of the cartridge at a location adjacent to a staple-receivingrecess, and each guide member has an inner arcuate surface configured toguide a leg of a staple along an arcuate path and into tissue engagedbetween the first and second jaws. In a further aspect, each guidemember includes opposed sidewalls configured to support and maintainalignment of a staple being rotatably advanced therethrough.

Each guide member is formed on and protrudes outward from atissue-contacting surface of the cartridge. Further, each guide membercan be formed on an inwardly-facing surface of the cartridge, oppositeto a tissue-contacting surface. In one aspect each guide-member issubstantially U-shaped such that the guide member is configured tocontact three sides of a staple being advanced therethrough.

According to another aspect, a surgical stapling device comprises anelongate shaft having an end effector coupled to a distal end thereofand including a cartridge-receiving jaw and an anvil pivotally coupledto the cartridge-receiving jaw. The device also includes a staplecartridge disposed within the cartridge-receiving jaw, wherein thestaple cartridge has a carrier disposed therein with a plurality ofplastically deformable staples formed on the carrier. The staplecartridge also has a deck with a plurality of openings formed therein,wherein each opening is configured to receive one of the plurality ofstaples therethrough. Each opening further has a guide member extendingoutwardly from the deck that is configured to guide a staple beingadvanced through the opening along an arcuate path.

Each guide member can extend outwardly from the deck in a directiontoward the anvil. Alternatively, each guide member can extend outwardlyfrom the deck in a direction away from the anvil.

In one aspect, each guide member includes opposed sidewalls that engageopposed sides of a staple being advanced therethrough. Further, eachguide member can include a curved inner surface that guides the staplesalong a curved pathway.

BRIEF DESCRIPTION OF THE DRAWINGS

This invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of one embodiment of a surgical deviceconfigured to apply fasteners to tissue and including an end effector,the end effector being in a closed position;

FIG. 2 is a perspective view of the end effector of FIG. 1 in an openposition;

FIG. 3 is a perspective view of the end effector of FIG. 2 with oneembodiment of a cartridge removably coupled thereto;

FIG. 4 is a perspective, partially cross-sectional view of the endeffector and the cartridge of FIG. 3;

FIG. 5 is a perspective view of the cartridge of FIG. 3;

FIG. 6 is another perspective view of the cartridge of FIG. 3;

FIG. 7 is a perspective view of a sled of the cartridge of FIG. 3, thesled including a cutting element, and the cutting element being in afirst position;

FIG. 8 is a perspective view of the sled of FIG. 7 with the cuttingelement in a second position that is different from the first position;

FIG. 9 is a perspective view of one embodiment of a cartridge includinga plurality of guidance features and having a plurality of fastenersdisposed therein;

FIG. 10 is a perspective view of one of the fasteners of FIG. 9 beingdeployed and guided by one of the guidance features;

FIG. 11 is a perspective, partially cross-sectional view of anotherembodiment of a cartridge including a plurality of guidance features andhaving a plurality of fasteners disposed therein;

FIG. 12 is another perspective, partially cross-sectional view of thecartridge of FIG. 11 without the fasteners disposed therein;

FIG. 13 is another perspective, partially cross-sectional view of thecartridge of FIG. 11 with one of the fasteners being deployed and guidedby one of the guidance features;

FIG. 14 is a perspective view of one embodiment of a sled that includesa plurality of guidance features;

FIG. 15 is an end view of the sled of FIG. 14 with a plurality offasteners engaged with the plurality of guidance features;

FIG. 16 is a cross-sectional view of one of the fasteners and one of theguidance features of FIG. 15;

FIG. 17 is a cross-sectional view of one embodiment of a bottom jaw thatincludes a plurality of guidance features, the bottom jaw being part ofan end effector that also includes an upper jaw;

FIG. 18 is a perspective view of the bottom jaw of FIG. 74;

FIG. 19 is a cross-sectional view of another embodiment of a bottom jawthat includes a plurality of guidance features; and

FIG. 20 is another cross-sectional view of the bottom jaw of FIG. 19,the bottom jaw being part of an end effector that also includes an upperjaw.

DETAILED DESCRIPTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Further, in the present disclosure, like-named components of theembodiments generally have similar features, and thus within aparticular embodiment each feature of each like-named component is notnecessarily fully elaborated upon. Additionally, to the extent thatlinear or circular dimensions are used in the description of thedisclosed systems, devices, and methods, such dimensions are notintended to limit the types of shapes that can be used in conjunctionwith such systems, devices, and methods. A person skilled in the artwill recognize that an equivalent to such linear and circular dimensionscan easily be determined for any geometric shape. Sizes and shapes ofthe systems and devices, and the components thereof, can depend at leaston the anatomy of the subject in which the systems and devices will beused, the size and shape of components with which the systems anddevices will be used, and the methods and procedures in which thesystems and devices will be used.

It will be appreciated that the terms “proximal” and “distal” are usedherein with reference to a user, such as a clinician, gripping a handleof an instrument. Other spatial terms such as “front” and “back”similarly correspond respectively to distal and proximal. It will befurther appreciated that for convenience and clarity, spatial terms suchas “vertical” and “horizontal” are used herein with respect to thedrawings. However, surgical instruments are used in many orientationsand positions, and these spatial terms are not intended to be limitingand absolute.

FIG. 1 illustrates one embodiment of a surgical device 1100 that can beconfigured to apply staples to tissue. The device 1100 in thisillustrated embodiment includes a linear stapler configured to applylinear rows of staples. Other embodiments of surgical devices that canbe configured to apply staples to tissue are described in U.S. Pat. No.5,465,895 entitled “Surgical Stapler Instrument” filed Feb. 3, 1994,U.S. Pat. No. 7,000,818 entitled “Surgical Stapling Instrument HavingSeparate Distinct Closing And Firing Systems” filed May 20, 2003, U.S.Pat. No. 7,669,746 entitled “Staple Cartridges For Forming StaplesHaving Differing Formed Staple Heights” filed on Aug. 31, 2005, and U.S.Pat. Pub. No. 2014/0175146 entitled “Microcutter Stapling ApparatusClamp And Deploy Mechanisms Systems And Methods” filed Dec. 19, 2013,which are hereby incorporated by reference in their entireties.

Referring again to FIG. 1, the device 1100 can include a proximal handleportion 1102 having an elongate shaft 1104 extending distally therefrom.As also shown in FIG. 2 and FIG. 3, the shaft 1104 can have an endeffector 1106 coupled to a distal end thereof. The end effector 1106 canbe coupled to the shaft 1104 at a pivot joint 1108. A proximal end ofthe end effector 1106 can be pivotally coupled to the joint 1108 at adistal end of the shaft 1104. The end effector 1106 in this illustratedembodiment includes a tissue grasper having a pair of opposed first andsecond jaws 1110 a, 1110 b configured to move between open and closedpositions. The first jaw is also referred to herein as a “bottom jaw”and a “cartridge jaw,” and the second jaw is also referred to herein asan “upper jaw” and an “anvil.” As discussed further below, the handleportion 1102 can be configured to be manipulated to effect the openingand closing of the opposed jaws 1110 a, 1110 b, e.g., movement of one orboth the jaws 1110 a, 1110 b about the pivot joint 1108, and the handleportion 1102 can be configured to be manipulated to effect the firing ofstaples (not shown) from a one of the jaws 1110 a, 1110 b, e.g., abottom or cartridge one of the jaws 1110 a. The staple firing can beindependent of the opening and closing of the jaws 1110 a, 1110 b.

The handle portion 1102 can have a variety of sizes, shapes, andconfigurations. The handle portion 1102 can include a main housing 1121,which can house a variety of elements therein and can have some elementsaccessible outside thereof, such as a movable trigger 1122 and astationary handle 1124. The movable trigger 1122 can be configured to bemanually manipulated to move the movable trigger 1122 relative to thestationary handle 1124 so as to, e.g., effect closing of the jaws 1110a, 1110 b.

The shaft 1104 can have a variety of sizes, shapes, and configurations.In an exemplary embodiment, the shaft 1104 can be rigid, e.g., made froma generally non-bendable material such as a metal (e.g., stainlesssteel, titanium, etc.) or a hard polymer. In other embodiments, theshaft 1104 can be configured to bend, such as being made from agenerally flexible material, by including one or more articulationregions, etc. The shaft 1104 can have any longitudinal length, althoughin an exemplary embodiment it can be long enough to allow the handleportion 1102 to be manipulated outside a patient's body while the shaft1104 extends through an opening in the body with the end effector 1106disposed within a body cavity. In this way, the end effector 1106 can beeasily manipulated when the device 1100 is in use during a surgicalprocedure. The shaft 1104 can have any diameter. For example, theshaft's diameter can be less than or equal to about 10 mm, e.g., lessthan or equal to about 7 mm, less than or equal to about 5 mm, etc.,which can allow for insertion of the shaft 1104 through an minimallyinvasive access device, e.g., a trocar, a cannula, a multiport accessdevice, etc., such as during a laparoscopic surgical procedure. The endeffector 1106 coupled to the shaft's distal end can have a diameterequal to or less than the shaft's diameter, at least when the jaws 1110a, 1110 b are in the closed position, which can facilitate insertion ofthe device's distal portion into a patient's body.

The end effector 1106 can have a variety of sizes, shapes, andconfigurations. In an exemplary embodiment, the end effector 1106 can berigid. As shown in FIG. 2 and FIG. 3, the end effector 1106 includingthe first and second jaws 1110 a, 1110 b can be disposed at a distal endof the surgical device 1100. As in this illustrated embodiment, when thejaws 1110 a, 1110 b move between the open and closed positions, thesecond jaw 1110 b can be configured to remain stationary relative to theshaft 1104, and the first jaw 1110 a can be configured to move relativeto the shaft 1104 and the second jaw 1110 b by pivoting at the pivotjoint 1108.

The end effector 1106 can be configured to releasably and replaceablyseat a cartridge 1112 therein, as shown in FIG. 3 and FIG. 4. In thisway, when the staples have been fired from the cartridge 1112, thecartridge 1112 can be removed from the second jaw 1110 b and,optionally, replaced with another cartridge having another plurality ofstaples disposed therein. FIG. 2 shows the end effector 1106 without thecartridge 1112 seated therein. The end effector 1106 can be configuredto receive the cartridge 1112 in the first jaw 1110 a thereof, e.g., ina channel formed in the first jaw 1110 a. The first jaw 1110 a can beconfigured to seat cartridges of different sizes, thereby facilitatingversatility of the device 1100.

The cartridge 1112 can have a variety of sizes, shapes, andconfigurations, as will be appreciated by a person skilled in the art.As shown in FIG. 4, FIG. 5, and FIG. 6, the cartridge 1112 can include asled 1120 and can have a plurality of staples 1116 disposed therein. Thesled 1120 is also illustrated in FIG. 7 and FIG. 8. The cartridge 1112can include a plurality openings 1114 formed in a tissue engagingsurface 1118 thereof, as shown in FIG. 3, FIG. 5, and FIG. 6. Thestaples 1116 disposed in the cartridge 1112 can be configured to beejected from the cartridge 1112 through the openings 1114, e.g., onestaple 1116 out of each opening 1114 (as in this illustratedembodiment), two staples out of each opening 1114, etc. The openings1114 can define staple-receiving recesses of the cartridge 1112 in whichthe staples 1116 are seated prior to being ejected from the cartridge1112.

The staples 1116 can have a variety of sizes, shapes, andconfigurations. In this illustrated embodiment, the staples 1116 eachhave a D-shape and include a first leg that is substantially straightand a second leg that is curved. A person skilled in the art willappreciate that the first leg may not be precisely straight, e.g., dueto manufacturing tolerances, but nevertheless be considered to besubstantially straight. Each of the staples 1116 can be configured to beplastically deformable such that the staples 1116 can each be configuredto change shape, such as when the staple 1116 is pressed against atissue engaging surface (not shown) of the first jaw 1110 a that facesthe tissue engaging surface 1118 of the second jaw 1110 b, whileremaining a single unit, e.g., without either of the first and secondlegs breaking. A gap of space can exist between a terminal end of thefirst leg and a terminal end of the second leg. In other words, the “D”shape can have a gap therein. The gap of space can facilitate plasticdeformation of the staple 1116.

The staples 1116 can each be frangibly attached to a carrier 1126, alsoreferred to herein as a “carrier strip,” disposed within the cartridge1112. The staples 1116 can be frangibly attached to the carrier 1126 by,e.g., being stamped together with the carrier 1126 such that the staples1116 and the carrier 1126 forms a single piece. The staples 1116 caneach be configured to detach from the carrier 1126 when fired from thecartridge 1112. In some embodiments, some or all of the staples 1116 canbe frangibly attached to another element, such as another elementdisposed within the cartridge 1112, an inner surface of the cartridge1112, the tissue-engaging surface 1118 of the cartridge 1112, etc. Thecarrier 1126 can be fixedly attached to an upper surface of one or morerails 1128 defined by the cartridge 1112. The carrier 1126 can beconfigured to remain stationary relative to the cartridge 1112.

As shown in FIG. 3, FIG. 5, and FIG. 6, the cartridge 1112 can have alongitudinal slot 1130 formed therein. The longitudinal slot 1130 canextend along a substantially flat central portion 1118 f of thetissue-engaging surface 1118. The slot 1130 can be configured to have acutting element such as a knife (not shown) extend therethrough so as tobe configured to cut tissue engaged by the tissue-engaging surface 1118,as discussed further below. The openings 1114 can be formed in angledportions 1118a of the tissue-engaging surface 1118 on both sides of theslot 1130, as shown in FIG. 3, FIG. 5, and FIG. 6. In some embodiments,the tissue-engaging surface 1118 can be substantially flat, e.g., nothave angled portions, while in other embodiments, the tissue-engagingsurface 1118 can be angled, e.g., not have any substantially flatportions.

As shown in FIG. 5 and FIG. 6, the cartridge 1112 can include agap-setting feature 1142 configured to set of gap of space between thefirst and second jaws 1110 a, 1110 b when the jaws 1110 a, 1110 b areclosed and the cartridge 1112 is seated in the second jaw 1110 b. Inthis way, the gap-setting feature 1142 can be configured to define aminimum distance between the facing tissue-engaging surfaces of thefirst and second jaws 1110 a, 1110 b. The gap-setting feature 1142 canhave a variety of sizes, shapes, and configurations. As in thisillustrated embodiment, the gap-setting feature 1142 can include anindentation inward toward a lateral center of the cartridge 1112, wherea portion of a lateral edge of the cartridge 1112 immediately proximalto the gap-setting feature 1142 is located laterally inward relative toa portion of a lateral edge of the cartridge 1112 located immediatelydistal to the gap-setting feature 1142.

The sled 1120 of the cartridge 1112 can have a variety of sizes, shapes,and configurations. The sled 1120 can be configured to translatelongitudinally along the cartridge 1112 to cause deployment of thestaples 1116 therefrom and to cause tissue engaged by the end effector1106 to be cut with the cutting element extending through the slot 1130.The staples 1116 can be arranged longitudinally in the cartridge 1112,as shown in FIG. 4, and the sled 1120 can be configured to sequentiallyengage the longitudinally arranged staples 1116 as the sled 1120translates longitudinally. As illustrated in FIG. 7 and FIG. 8, the sled1120 can include a plurality of wedges 1136 and can include a cuttingelement 1134, which in this illustrated embodiment includes a knife witha blade 1132. The sled 1120 in this illustrated embodiment includes fourwedges 1136 but the sled 1120 can include another number of wedges 1136as appropriate for the arrangement of the staples 1116 in the cartridge1112. Each of the wedges 1136 can have a shape configured to cause thestaples 1116 contacted by that wedge 1136 to move upward toward thesecond jaw 1110 b through the openings 1114 and deform against thesecond jaw 1110 b. As shown in FIG. 6, the cartridge 1112 can include aplurality of longitudinal slots 1150 formed therein, each of the slots1150 being configured to slidably receive one of the wedges 1136therein. The slots 1150 can facilitate consistent, straight movement ofthe wedges 1136 through the cartridge 1112 to help ensure properengagement of the wedges 1136 with the staples 1116.

Each of the wedges 1136 can be attached to a base 1138 of the sled 1120and can be in a fixed position relative thereto. The base 1138 can havea guide element 1139 extending generally downward therefrom. The guideelement 1139 can be configured to slide within a channel formed in thecartridge 1112 that includes the sled 1120. The cutting element 1134 canalso be attached to the base 1138, but the cutting element 1134 can beconfigured to move relative to the base 1138. The cutting element 1134can be substantially laterally centered in the base 1138, which canfacilitate substantially central positioning of the cutting element 1134relative to tissue engaged by the end effector 1106.

The cutting element 1134 can be configured to be movable relative to aremainder of the sled 1120 between a first position, shown in FIG. 7,and a second position, shown in FIG. 6 and FIG. 8. The first positioncan be an initial position of the cutting element 1134. In the firstposition, also referred to herein as a “stowed position,” the blade 1132can be generally obscured, e.g., oriented generally downward as shown inthe embodiment of FIG. 4, FIG. 5, FIG. 6, and FIG. 7, which can helpprevent the blade 1132 from inadvertent cutting, such as accidentallycutting a user of the device 1100 during seating of the cartridge 1120within the end effector 1104 and/or premature cutting of tissue engagedby the end effector 1104. The base 1138 can have a cavity 1144 formedtherein, as shown in FIG. 6, which can be configured to seat the cuttingelement 1134 at least partially therein when the cutting element 1134 isin the first position. In the second position, also referred to hereinas an “upright position,” the blade 1132 can be generally unobscured andfacing a distal direction as shown in the embodiment of FIG. 6 and FIG.8, which can allow the blade 1132 to extend through the slot 1130 andcut tissue engaged by the end effector 1106.

The sled 1120 can include a pivot member 1140 configured to facilitatemovement of the cutting element 1134 relative to the remainder of thesled 1120. The pivot member 1140 can have a variety of sizes, shapes,and configurations. The pivot member 1140 can be attached to the cuttingelement 1134 such that engagement of the pivot member 1140 can cause thecutting element 1134 to pivot about a pivot point so as to move relativeto the remainder of the sled. As in this illustrated embodiment thepivot member 1140 can include two separate pins extending laterally fromopposite sides of the cutting element 1134. In other embodiments, thepivot member 1140 can include a single pin extending through the cuttingelement 1134 to extend laterally from opposite sides therefrom, a singlepin extending laterally from one side of the cutting element 1134, etc.At the pivot point, the sled 1120 can include a pivot axle 1146extending laterally from the cutting element 1134, and can include anaxle cavity 1148 formed in the base 1138 and configured to receive thepivot axle 1146 therein.

The surgical devices described herein can be used in a variety ofsurgical procedures. In an exemplary embodiment, the procedure can be aminimally invasive procedure in which the surgical device can beadvanced into a body of a patient through a relatively small opening inthe patient. In a minimally invasive surgical procedure, one or moreintroducer devices (not shown), e.g., a cannula, a trocar, etc., can beadvanced through an opening in the patient to provide access to asurgical site. A person skilled in the art will appreciate that one ormore viewing devices, e.g., a scoping device such as an endoscope, canbe advanced into the body through the incision or through anotheropening, e.g., another incision or a natural orifice, to providevisualization of the surgical site from outside the body. As will beappreciated by a person skilled in the art, the surgical device can beadvanced into the patient's body in a variety of ways, such as by beinginserted transorally therein, inserted through an introducer device,inserted through a scoping device, inserted directly through anincision, etc. Although the following embodiment of use of a surgicaldevice in a surgical procedure is described with respect to the device1100 of FIG. 1, any of the surgical devices described herein can besimilarly used.

The surgical devices described herein can have any one or morevariations to facilitate effective use of the device. Examples of suchvariations are described further below.

In some embodiments, a surgical device such as the above-mentionedsurgical device 1100 can be configured to facilitate guidance offasteners during deployment of the fasteners into tissue. In general,the surgical device can include one or more guidance features configuredto facilitate guidance of the fasteners during ejection of the fastenersfrom the cartridge. The one or more guidance features can be configuredto reduce lateral movement of the fasteners during deployment thereof,thereby allowing the fasteners to be more accurately positioned withinthe tissue relative to one another and relative to the tissue. Byhelping to guide the fastener into the tissue, the fastener can be lesslikely to skew laterally during deployment into the tissue due toresistance of the tissue and/or tissue flow can be reduced duringfastener deployment. The fasteners can thus be effectively positionedrelative to one another and to the tissue to facilitate proper healingand/or sealing of the tissue. This can be particularly beneficial inrelatively thick tissue because the tissue can provide relatively highresistance to the fastener being deployed therein. In an exemplaryembodiment, each of the one or more guidance features can be configuredto support a fastener on three sides thereof during deployment of thefastener, thereby helping to minimize lateral movement of the fastenerduring the deployment. The one or more guidance features can be formedon the cartridge, e.g., formed on a surface thereof or formed on a sleddisposed in the cartridge, and/or can be formed on a jaw that seats thecartridge.

A surgical device can be configured to guide fasteners during deploymentthereof in a variety of ways. In the embodiments described below,staples are used as examples of fasteners, but as will be appreciated bya person skilled in the art, other types of fasteners can be similarlyconfigured and used.

In some embodiments, a cartridge having a plurality of fastenersdisposed therein can include one or more guidance features, alsoreferred to herein as “guide members,” configured to guide the fastenersduring firing of the fasteners from the cartridge. As discussed herein,the cartridge can be configured to be removably and replaceably seatedin an end effector of a surgical device. FIG. 9 and FIG. 10 illustrateone embodiment of a cartridge 3000 that includes a plurality offasteners 3008 disposed therein, a sled 3004 including a movable cuttingelement 3006, and one or more guide members 3002 configured to guide thefasteners 3008 during firing of the fasteners 3008 from the cartridge3000. In this illustrated embodiment, the fasteners 3008 include staplessimilar to the above-mentioned staples 1116, but as also mentionedabove, other types of staples or fasteners can be used. As in thisillustrated embodiment, the one or more guide members 3002 can each beformed on and protrude upward from a tissue-engaging surface 3010 of thecartridge 3000, e.g., in a direction toward an anvil (not shown) of thesurgical device. The guidance provided by the guide members 3002 canthus be provided after the fasteners 3008 have at least partially exitedtheir respective fastener-receiving recesses 3012 so as to pass abovethe tissue-engaging surface 3010. The guide members 3002 protrude upwardfrom the tissue-engaging surface 3010 can allow the guide members 3002to be located in a gap of space between the tissue-engaging surface 3010and a tissue-engaging surface (not shown) of the anvil, which can helpgrip tissue positioned within the gap of space. Movement or flow of thetissue within the gap of space can thus be reduced, which can allow thetissue to be more effectively fastened.

The guide members 3002 can have a variety of sizes, shapes, andconfigurations. Each of the guide members 3002 can have an inner arcuatesurface, as in this illustrated embodiment. The inner arcuate surfacecan be configured to guide a second leg 3014 of the staple 3008 along anarcuate path as the staple 3008 is being deployed into a tissue (notshown). As discussed herein, the staple 3008 can also include asubstantially straight first leg (not shown) connected to the curvedsecond leg 3014. The inner arcuate surface of each of the guide members3002 can be shaped to mimic a curvature of the fastener's second leg3014, thereby helping to maximize an amount of movement support for thefastener 3008 during deployment thereof. As in this illustratedembodiment, the guide members 3002 can each be U-shaped with opposedsidewalls and a curved intermediate portion connecting the sidewalls. Asshown in FIG. 10, the sidewalls can be configured to support andmaintain alignment of the fastener during deployment. Being opposed, thesidewalls can help prevent lateral movement of the fastener 3008 duringdeployment. As shown in FIG. 10, the opposed sidewalls and the curvedintermediate portion can be configured to contact three sides of thefastener 3008 as the fastener is guided by the guide member 3002 duringdeployment, thereby helping to prevent lateral movement of the fastener3008 due to the sidewalls and helping to prevent distal movement of thefastener 3008 due to the intermediate portion.

Each of the guide members 3002 can be formed adjacent to and on a distalside of their respective fastener-receiving recesses 3012, as shown inthis illustrated embodiment. In this way, when the fasteners 3008 aredriven out of the cartridge 3000 in response to distal translation ofthe sled 3004 through the cartridge, the guide members 3002 can beconfigured to guide their respective fasteners' second legs 3014 as thesecond legs 3014 rotate out of the cartridge 3002 to lead the fasteners3008 out of the cartridge 3002.

In the embodiment of FIG. 9, the one or more guide members 3002 arelocated above the tissue-engaging surface 3010. In other embodiments, acartridge can include one or more guide members located below atissue-engaging surface of the cartridge. Being located below thetissue-engaging surface can help prevent the guide members from snaggingon and/or otherwise interfering with tissue engaged by the cartridgeand/or from affecting an amount of space between facing tissueengagement surfaces of an end effector within which tissue can bepositioned and clamped. In some embodiments, a cartridge can include oneor more guide members that are located both above and below atissue-engaging surface thereof.

FIG. 11, FIG. 12, and FIG. 13 illustrate another embodiment of acartridge 3016 that includes a plurality of fasteners 3018 disposedtherein, a sled (not shown), and one or more guide members 3020configured to guide the fasteners 3018 during firing of the fasteners3018 from the cartridge 3016. The fasteners 3018, the cartridge 3016,and the guide members 3020 can be generally configured and used similarto the fasteners 3008, the cartridge 3000, and the guide members 3002,respectively, of FIG. 9 and FIG. 10. In this illustrated embodiment,however, the one or more guide members 3020 are each located below atissue-engaging surface 3022 of the cartridge 3016 and are each formedadjacent to and on a distal side of a staple-receiving recess 3024.Similar to the guide members 3002 of FIG. 9, the guide members 3020 caneach include opposed sidewalls (best shown in FIG. 12) and an innerarcuate surface shaped to mimic a curvature of the fastener's second leg3026, thereby allowing the guide members 3020 to support theirassociated fasteners 3008 on three sides thereof during fastenerdeployment.

As discussed above, one or more guide members can be formed on a surfaceof a cartridge. In other embodiments, as mentioned above, a cartridgecan include one or more guide members formed on a sled disposed withinthe cartridge and configured to translate therethrough to drivefasteners out of the cartridge. The sled can thus be configured tosupport and maintain alignment of fasteners being deployed in responseto the sled's translation relative thereto. The sled including guidancefeatures can help allow existing cartridges to be only slightlymodified, or not modified at all, in order to include guidance featuresbecause the sleds including guidance features can be incorporated intothe existing cartridges.

FIG. 14 illustrates one embodiment of a sled 3028 that includes one ormore guide members 3030 a, 3030 b, 3030 c, 3030 d, a cutting element3032 configured to move between first and second positions, one or morewedges 3034 a, 3034 b, 3034 c, 3034 d configured to drive fasteners fromthe cartridge, and a base 3036. The sled 3028 can be used with any ofthe cartridges discussed herein. Each of the wedges 3034 a, 3034 b, 3034c, 3034 d can have one of the guide members 3030 a, 3030 b, 3030 c, 3030d associated therewith. Thus, a number of the wedges 3034 a, 3034 b,3034 c, 3034 d can equal a number of the guide members 3030 a, 3030 b,3030 c, 3030 d. As in this illustrated embodiment, as also shown in FIG.15 and FIG. 16, the guide members 3030 a, 3030 b, 3030 c, 3030 d caninclude lateral guide walls of the wedges 3034 a, 3034 b, 3034 c, 3034d. The guide walls can be configured to provide lateral support tofasteners being deployed by the sled 3028 via engagement with the wedges3034 a, 3034 b, 3034 c, 3034 d. Without the guide walls, the fastenermay only receive guidance from a pivot point about which the fastenerrotates during deployment thereof. This pivot point, however, is weakwhen the fastener is configured to break off from the pivot point duringfastening, such as with the fasteners 1116 in the above-mentioned device1100.

As shown in FIG. 15 and FIG. 16, when the sled 3028 engages fasteners3036 a, 3036 b, 3036 c, 3036 d so as to push and deploy the fasteners3036 a, 3036 b, 3036 c, 3036 d, the guide walls defined by the guidemembers 3030 a, 3030 b, 3030 c, 3030 d can engage the fasteners 3036 a,3036 b, 3036 c, 3036 d and provide directional movement guidance suchthat lateral movement of the fasteners 3036 a, 3036 b, 3036 c, 3036 dcan be minimized. In this illustrated embodiment, the fasteners 3036 a,3036 b, 3036 c, 3036 d include staples similar to the above-mentionedstaples 1116, but as also mentioned above, other types of staples orfasteners can be used.

As discussed above, one or more guide members can be formed on a surfaceof a cartridge and/or can be formed on a sled. In other embodiments, asmentioned above, a jaw that seats a cartridge, e.g., a jaw configured toreleasably and replaceably receive a cartridge, can include one or moreguide members. The jaw, and hence an end effector that includes the jaw,can thus be configured to support and maintain alignment of fastenersbeing deployed therefrom. The jaw including guidance features can helpallow existing cartridges to be used with a device including guidancefeatures without the cartridges having to be modified.

FIG. 17 and FIG. 18 illustrate an embodiment of a jaw 3038 that includesone or more guide members. The jaw 3038 is shown in FIG. 17 as part ofan end effector 3040 that includes the jaw 3038 and a second jaw 3042,e.g., an anvil. The one or more guide members can be in the form ofopposed substantially vertical sidewalls 3044 a, 3044 b configured toengage side of a cartridge received within the jaw 3038, andsubstantially flat bottom surfaces 3046 a, 3046 b on either side of acentral longitudinal channel 3048 configured to slidably receive a drivebeam, also referred to herein as an “I-beam,” through the jaw 3038. Aperson skilled in the art will appreciate that the vertical sidewalls3044 a, 3044 b may not be precisely vertical, e.g., due to manufacturingtolerances, but nevertheless be considered to be substantially vertical.Similarly, a person skilled in the art will appreciate that the flatbottom surfaces 3046 a, 3046 b may not be precisely flat, e.g., due tomanufacturing tolerances, but nevertheless be considered to besubstantially flat. The substantially flat bottom surfaces 3046 a, 3046b can help provide a better seat for the cartridge within the jaw 3038for vertically created tissue loads. The substantially verticalsidewalls 3044 a, 3044 b can be configured to help minimize cartridgespread, e.g., movement of the cartridge within the jaw 3038 in which itis seated, during fastener deployment, e.g., due to the I-beam slot,which can help provide more robust fastener formation. Cartridge spreadcan become more pronounced the thicker the tissue being grasped andfastened by the end effector 3040. The substantially vertical sidewalls3044 a, 3044 b can help resist the vertical forces created duringmovement of the I-beam for fastener deployment and can provide aboutthree times more resistance than sidewalls that are not substantiallyvertical.

FIG. 19 and FIG. 20 illustrate another embodiment of a jaw 3050 thatincludes one or more guide members. The jaw 3050 is shown in FIG. 20 aspart of an end effector 3052 that includes the jaw 3052 and a second jaw3054, e.g., an anvil. The jaw 3050 can be generally configured and usedsimilar to the jaw 3038 of FIG. 17 and FIG. 18. The jaw 3050 in thisillustrated embodiment includes one or more guide members in the form ofopposed substantially vertical sidewalls 3056 a, 3056 b configured toengage side of a cartridge received within the jaw 3050, and asubstantially flat bottom surface 3058 along which an drive beam 3060can be configured to translate through the jaw 3050. FIG. 17 illustratesan embodiment of spreading forces 3062 a, 3062 b that the substantiallyvertical sidewalls 3056 a, 3056 b can be configured to counter duringfastener deployment.

A person skilled in the art will appreciate that the present inventionhas application in conventional minimally-invasive and open surgicalinstrumentation as well application in robotic-assisted surgery.

The devices disclosed herein can also be designed to be disposed ofafter a single use, or they can be designed to be used multiple times.In either case, however, the device can be reconditioned for reuse afterat least one use. Reconditioning can include any combination of thesteps of disassembly of the device, followed by cleaning or replacementof particular pieces and subsequent reassembly. In particular, thedevice can be disassembled, and any number of the particular pieces orparts of the device can be selectively replaced or removed in anycombination. Upon cleaning and/or replacement of particular parts, thedevice can be reassembled for subsequent use either at a reconditioningfacility, or by a surgical team immediately prior to a surgicalprocedure. Those skilled in the art will appreciate that reconditioningof a device can utilize a variety of techniques for disassembly,cleaning/replacement, and reassembly. Use of such techniques, and theresulting reconditioned device, are all within the scope of the presentapplication.

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A surgical fastening device, comprising: anelongate shaft; an end effector coupled to a distal end of the elongateshaft, the end effector including first and second opposed jaws coupledto one another and configured to engage tissue therebetween; and astaple cartridge disposed within the first jaw, the staple cartridgeincluding a plurality of staple-receiving recesses formed therein, aplurality of D-shaped staples configured to rotate about a pivot pointinto tissue engaged between the first and second jaws, each staple beingdisposed within a staple-receiving recess, and a plurality of guidemembers formed on the cartridge, each guide member extending from asurface of the cartridge at a location adjacent to a staple-receivingrecess, and each guide member having an inner arcuate surface configuredto guide a leg of a staple along an arcuate path and into tissue engagedbetween the first and second jaws.
 2. The device of claim 1, whereineach guide member includes opposed sidewalls configured to support andmaintain alignment of a staple being rotatably advanced therethrough. 3.The device of claim 1, wherein each guide member is formed on andprotrudes outward from a tissue-contacting surface of the cartridge. 4.The device of claim 1, wherein each guide member is formed on aninwardly-facing surface of the cartridge, opposite to atissue-contacting surface.
 5. The device of claim 1, wherein eachguide-member is substantially U-shaped such that the guide member isconfigured to contact three sides of a staple being advancedtherethrough.